Lecture 9/10 Flashcards
What are the three parts of the preoperative evaluation?
“-Data collection & documentation
- Obtaining a complete problem list
- analysis and discussion of anesthesia management options
- BONUS: presenting this information to the patient”
What should be discussed for anesthesia/surgery preparation?
“-Discuss fasting times for clear fluids and foods
- Discuss which meds to dis/continue and when
- Discuss what new medications the pt will start on”
What medications are continued to the time of surgery?
“-Certain antihypertensives
- Most cardiac meds, including beta blockers
- Systemic glucocorticoids
- Statins
- narcotic pain meds
- MAOIs
- Anxiolytics”
What meds are often held the day of surgery?
“-Insulins
- Hyperglycemic agents (Metformin)
- Diuretics
- High dose ASA and NSAIDS”
Use clinical judgement to determine if the following should be held:
“-ACEI/ARBs
- Long acting insulin
- Low dose ASA
- Antiplatelet agents (ex: plavix/clopidogril)”
What medications have protocols for use pre/during surgery?
“-beta-blockers
-statins
Don’t memorize the protocols”
What type of H&P should you take on a patient? A surgical H&P or an IM H&P?
Both! A good H&P should cover both topics thoroughly. The internal medicine H&P best models the desired level of depth required.
What components make up a pre-op “chief complaint”?
“-What procedure is the pt having?
- When is the surgery happening?
- Give a one-word diagnosis that the surgery is treating.
- Patient status? (Already inpatient? Admitted day of surgery? Admission prior to surgery? Why?)”
What is included in the anesthesia HPI?
“Describe the symptom with the following:
- Where?
- When did this start?
- What major diagnostic tests have been done?
- What aggrivates the problem, how does it affect the pt’s life?”
What do we want from the PMH?
“Detailed description of any non-resolved, chronic, or life-long conditions.
-How’s it treated?
-Pt satisfied w/ degree of control?
-Primary physician satisfied w/ degree of control?
If two of the above are a ““no””, then ask what else can be done, how long it will take, and what specalized interventions are necessary.”
Which organ system received lots of love during the anesthesia pre-op eval?
Cardiovascular
What guidelines should be used for anesthesia care for cardiac issues?
“AHA/ACC guidelines
-Used to evaluate pts (esp w/ CAD and CAD risk)
-Used to evaluate pts for noncardiac surgery
-Used to reduce invasive and threatening procedures on all of our patients
“
What are the four “active cardiac conditions” must be evaluated prior to an elective surgery?
“-Unstable coronary syndromes
-Decompensated CHF
-Significant dysrhythmias (high grade AV block, Mobitz II AV block, third-degree AV block, symptomatic ventricular arrhythmias, supraventricular arrhythmias, newly ID’d v-tach, symptomatic bradycardia.
-Severe/poorly compensated valvular disease (severe aortic stenosis, severe mitral stenosis,symptomatic mitral stenosis)
“
Can’t remember the four active cardiac conditions?
-They’re conditions that the pt should be in the hospital (likely in the Critical Care Unit) for.
What is the scale for exercise tolerance that we use?
METs. 1 to >10 is the range; MET=4 means a patient can carry a bag of groceries up the stairs without significant SOB. This ability is enough to allow the patient to have surgery.
